Lit Matters #1: Dalbavancin Reduces SSTI Admits

Moderately severe skin and soft tissue infection often triggers admission mainly to deliver IV antibiotics. A single-dose ED pathway using dalbavancin cut hospitalization substantially in stable SSTI patients with presumed gram-positive infection, while raising mostly mild adverse events.

Dalbavancin for SSTI Disposition

• Disposition-changing antibiotic option: Single-dose IV dalbavancin offers an outpatient path for selected moderately severe SSTIs when the main reason for admission is parenteral gram-positive coverage.
• Headline hospitalization reduction: Hospitalization fell from 38.5% with usual care to 17.6% after pathway implementation, a memorable effect size for patients who otherwise look admit-for-IV-only.
• Patient selection boundaries: The pathway targeted clinically stable SSTI patients felt to need IV therapy but still appropriate for discharge, while excluding sepsis, immunosuppression, IV drug use, and high-risk wound types.
• Single-dose renal adjustment: Dalbavancin was given as a one-time IV dose with creatinine-clearance adjustment, keeping treatment simple at the bedside. We get into the practical selection details in the episode.
• Follow-up as safety net: Early reassessment mattered: patients received a 24-hour phone call and a 48- to 72-hour follow-up visit, underscoring that outpatient management still needs a deliberate backstop.
• Adverse event tradeoff: Adverse events were more common in the pathway group, but most were mild and no infection-related or antibiotic-related deaths occurred in either arm.